Abstract
BackgroundEducation has attracted more attention as a key determinant of health in later life. In this study, the hypothesis that widened educational disparities in health can be observed in later life was investigated, and the factors that mediated the association between education and changes in health were also assessed.MethodsUsing the 9-year (10-wave) longitudinal data of 20,024 individuals (9320 men and 10,704 women) aged 50–59 years at baseline, collected from a nationwide population survey in Japan (2005–2014), the changes in self-rated health, functional limitations, and psychological distress between educational levels were compared. Mediation analysis was further conducted to assess the factors that mediated the association between education and changes in health, with reference to six types of potential mediators (household spending, social participation, leisure-time physical activity, smoking, problem drinking, and regular health check-ups). The analyses were conducted separately for men and women.ResultsAll three health variables rapidly deteriorated among lower-educated men and women. For men, the six potential mediators mediated 55.2%, 64.3%, and 47.3% of the associations between educational levels and changes in self-rated health, functional limitations, and psychological distress, respectively. The proportions for women were 42.0%, 49.5%, and 58.8%, respectively. Social participation was the primary mediator, followed by physical activity, regular health check-ups, and smoking. In general, no substantial or consistent differences were observed between men and women.ConclusionsThe results suggested that policy measures that encourage social participation and promote healthy behaviors can improve educational disparities in health in later life.
Highlights
Education has attracted more attention as a key determinant of health in later life
For both men and women, Self-rated health (SRH) and functional limitations at baseline were worse among lower-educated individuals than middle−/highereducated ones, whereas no difference was observed in terms of psychological distress
Over the 9-year period, self-rated health and psychological distress deteriorated among lower-educated men, while functional limitations and psychological distress deteriorated among lowereducated women
Summary
Education has attracted more attention as a key determinant of health in later life. In this study, the hypothesis that widened educational disparities in health can be observed in later life was investigated, and the factors that mediated the association between education and changes in health were assessed. Health is predicted to deteriorate more rapidly with age for lower-educated individuals than for higher-educated individuals, which is known as the cumulative disadvantage hypothesis [5]. In line with this hypothesis, several studies have demonstrated that educational level is a key determinant of health disparities in later life among other several aspects of health, including mortality, disability, frailty, chronic diseases, mental health, selfrated health, or other health variables [5,6,7,8,9,10,11,12,13].
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